For Starters, I want to thank anyone who takes the time to read this and give me a little perspective. I just got my final C&P results after a series of claims. Currently I am 94% combined rating if I include my Sleep apnea claim (The Dr. wrote it was medically neccesary to use the CPAP, so I do expect the 50%. This C&P below was conducted to separate my anxiety disorder from my TBI disorder. Currently I have a 70% rating for Anxiety with residuals of TBI. I was wondering if anyone could read this and tell me if they think I can expect a separate rating for TBI memory loss based on the Dr's opinion stating that my issue is 80% anxiety and 20% TBI (see note 2b below). If I can get at least a 10% for TBI in addition to the 70% for anxiety, It should push me over the threshhold of 100% schedular. The only edits I made to this was to remove names. Again, thank you for your time and expertise 70% Anxiety (Trauma with TBI residuals) 50% Sleep Apnea 20% Degenerative Disc Disease 20% Upper Neuropathy Right / 20% Upper Neuropathy Left 10% Lower Radiculopathy Right / 10% Lower Radiculopathy Left 0% TBI Migraines LOCAL TITLE: COMP AND PEN NOTE STANDARD TITLE: C & P EXAMINATION NOTE DATE OF NOTE: JAN 28, 2019@14:30 ENTRY DATE: JAN 30, 2019@11:11:26 AUTHOR: *********** E EXP COSIGNER: URGENCY: STATUS: COMPLETED Mental Disorders (other than PTSD and Eating Disorders) Disability Benefits Questionnaire Name of patient/Veteran: ***** Is this DBQ being completed in conjunction with a VA 21-2507, C&P Examination Request? [X] Yes [ ] No SECTION I: ---------- 1. Diagnosis ------------ a. Does the Veteran now have or has he/she ever been diagnosed with a mental disorder(s)? [X] Yes [ ] No ICD code: 300.00 If the Veteran currently has one or more mental disorders that conform to DSM-5 criteria, provide all diagnoses: Mental Disorder Diagnosis #1: Unspecifed Anxiety disorder, chronic, severe disorder. ICD code: 300.00 Comments, if any: Vet had been seen initially on 2/11/18 for Mental Health C+P exam done by Dr. *****(which proposed "Anxiety disorder, NOS" then, while f/u C+P exam on 2/16/14 had proposed Other specified trauma and stressor related disorder(as vet had been in IED blast in 2006 - see Mental Disorder diagnosis #2 below. Unspecified anxiety disorder is synonymous with Neurosis - which vet is already 70% SC for, in combination with residuals of TBI apparently). I am therefore not intending to change his Neurosis condition now, but Unspecified anxiety disorder is most accurate diagnosis consistent with DSM-V, as I see it now. Mental Disorder Diagnosis #2: Cognitive disorder due to Closed Head iInjury(CHI), due to 6/1/2006 "double-attacked anti-tank mine" IED blast. ICD code: 294.9 Comments, if any: Vet was in 2nd Iraq combat deployment - out of 3 tours he served there - when 6/1/06 IED hit his heavy equipment vehicle(which vet had referred to as 'palitizing loading system'). b. Medical diagnoses relevant to the understanding or management of the Mental Health Disorder (to include TBI): Vet is already 0% SC for migraine headaches. Comments, if any: Vet is already SC for migraine headaches. Vet is already 20% SC for Intervertebral DIsc Syndrome, 20% SC for Paralysis of musculospiral nerve(x2), 10% SC fo paralysis of sciatic nerve(x2). Vet also apparently had a 2/15/18 sleep study done that indicated a mild sleep apnea condition. 2. Differentiation of symptoms ------------------------------ a. Does the Veteran have more than one mental disorder diagnosed? [X] Yes [ ] No b. Is it possible to differentiate what symptom(s) is/are attributable to each diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to each diagnosis and discuss whether there is any clinical association between these diagnoses Symptoms(i.e., anxiety, sleep problmes) are due to Unspecified anxiety disorder, while symptoms(memory problems, headaches) are due to Cognitive disorder due to CHI. c. Does the Veteran have a diagnosed traumatic brain injury (TBI)? [X] Yes [ ] No [ ] Not shown in records reviewed d. Is it possible to differentiate what symptom(s) is/are attributable to TBI and any non-TBI mental health diagnosis? [X] Yes [ ] No [ ] Not applicable (N/A) If yes, list which symptoms are attributable to TBI and which symptoms are attributable to a non-TBI mental health diagnosis see 2b above. 3. Occupational and social impairment ------------------------------------- a. Which of the following best summarizes the Veteran's level of occupational and social impairment with regards to all mental diagnoses? (Check only one) [X] Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood b. For the indicated occupational and social impairment, is it possible to differentiate which impairment is caused by each mental disorder? [X] Yes [ ] No [ ] Not Applicable (N/A) If yes, list which occupational and social impairment is attributable to each diagnosis About 80% of vet's current occupational and social impairment is due to Unspecified anxiety disorder while about 20% is due to Cognitive disorder due to CHI. c. If a diagnosis of TBI exists, is it possible to differentiate which occupational and social impairment indicated above is caused by the TBI? [X] Yes [ ] No [ ] Not Applicable (N/A) If yes, list which impairment is attributable to TBI and which is attributable to any non-TBI mental health diagnosis see 3b above. SECTION II: ----------- Clinical Findings: ------------------ 1. Evidence Review ------------------ Evidence reviewed (check all that apply): [X] VA e-folder [X] CPRS [X] Other (please identify other evidence reviewed): Vet broiught a 4 page typed letter 1/12/19 done by himself describing in detail his current ongoing issues("I did not want to forget to tell you something important"), and vet admits it took him severalhours to complete(and which he kept revising many times). He brought a 2 page letter dated 1/27/19 done by his wife ******, a 2 page typed letter dated 1/17/19 done by mother ********, and a 1 page typed letter dated 1/27/19 done by vet's friend/combat comrade(served together in Iraq) named *******, and all 4 letter were reviewed by me. Evidence Comments: CPRS was reviewed by me and included my(***** MD) 12/5 18 Review TBI C+P exam report, as well as 5/16/14 C+P exam report done by Dr *****(sa well as Initial 2/18/11 MH C+P exam aslo done by Dr. ******. VBMS was reviewed by me and included vet's Army DD-214 signed b ***** which included MOS(88M30) Mortor Vehicle Operator,as well as E-6 discharge rank. His medals included CAB - among others, and he had Iraq combat dates of 1/03 - 7/03, 8/05 - 8/06, and 3/08 - 6/09 - for his 3 seperate Iraq combat tours. 2. History ---------- a. Relevant Social/Marital/Family history (pre-military, military, and post-military): Vet is married ****(and they have 2 sons(around ages 5 and nearly 7). b. Relevant Occupational and Educational history (pre-military, military, and post-military): Vet has been working in his current Passport Agency job since 2015(was at an administrative clerk(for a different agency) before that. c. Relevant Mental Health history, to include prescribed medications and family mental health (pre-military, military, and post-military): Vet has been on sertraline 150mg since 9/10/18 - it takes the "edge" off my problems, but he apparently has been having some sexual side effects(delayed ejaculation) related to that . d. Relevant Legal and Behavioral history (pre-military, military, and post-military): Vet has had no legal problems(and no jail time) since the 5/14/16 C+P exam report date. e. Relevant Substance abuse history (pre-military, military, and post-military): Vet has had no alcohol misuse disorder problems sicne 5/16/14. He has used no street drugs since 16/14. f. Other, if any: No response provided. 3. Symptoms ----------- For VA rating purposes, check all symptoms that actively apply to the Veteran's diagnoses: [X] Anxiety [X] Suspiciousness [X] Panic attacks that occur weekly or less often [X] Chronic sleep impairment [X] Mild memory loss, such as forgetting names, directions or recent events [X] Impairment of short- and long-term memory, for example, retention of only highly learned material, while forgetting to complete tasks [X] Disturbances of motivation and mood [X] Difficulty in establishing and maintaining effective work and social relationships [X] Difficulty in adapting to stressful circumstances, including work or a worklike setting [X] Obsessional rituals which interfere with routine activities 4. Behavioral observations -------------------------- Vet was totally genuine at the 1/28/19 Review Mental Health C+P exam. 5. Other symptoms ----------------- Does the Veteran have any other symptoms attributable to mental disorders that are not listed above? [X] Yes [ ] No If yes, describe: Vet admits to having anger difficulties, 'spacing out' at times, and general feeling of being confused/overwhelmed. He reports having lost his social "filter" abilities. He reports previously having been very "easygoing" prior to the military. Vet still gets nervous if seeing sandbags lying on the side of the road - left by construction crew(as that is what he looked for over in Iraq as being a potential IED.) He has to reorganize plates/trays a certain way, either at home or when leaving a restaurant, respectively. He denies having any suicidal thoughts("No, I'm addicted to life, I love breathing".). 6. Competency ------------- Is the Veteran capable of managing his or her financial affairs? [X] Yes [ ] No 7. Remarks (including any testing results), if any: --------------------------------------------------- Vet owns a pistol. He does not hunt - only tried it once, but did not get anything then. He denied having any current active suicidal or homicidal ideation.